Provider Demographics
NPI:1053175208
Name:SIMPLY SMILE DENTAL STUDIO PLLC
Entity type:Organization
Organization Name:SIMPLY SMILE DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANH
Authorized Official - Middle Name:TUAN
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-394-0999
Mailing Address - Street 1:2300 S MASON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6268
Mailing Address - Country:US
Mailing Address - Phone:281-394-0999
Mailing Address - Fax:281-394-1999
Practice Address - Street 1:2300 S MASON RD
Practice Address - Street 2:STE 104
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-394-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty